It is well known that smoking and alcohol are the main risk factors in head and neck cancer. More recent studies however show that HPV (human papilloma virus) infection is, perhaps, the most important factor, increasing cancer risk 32 times, compared to a mere 3 and 2.5 times increase in case of smoking and alcohol consumption, respectively. According to studies by M. Gillison, there are two head and neck cancer inducing methods: one through carcinogenetic effects (cancer inducing effects) of alcohol and smoking and the second through genomic instability caused by HPV, a sexually transmitted disease. Surprisingly, there seems to be no connection between HPV exposure and smoking or alcohol consumption.

The study carried out by M. Gillison, after comparing 100 patients recently diagnosed with oropharyngeal cancer with 200 healthy subjects, showed that oral-genital contact is closely related to oropharyngeal cancer. Study participants who said they had more than six different partners (for oral sex) had a 8.6 times higher risk to develop HPV-related oropharyngeal cancer than the other subjects. Virus transmission through kissing or touching cannot be ruled out, however.

HPV pool

HPV can be found in genital tract mucus, saliva, urine and sperm. Viral types with high carcinogenesis risk for head and neck cancer are types 16 and 18, just like with cervical cancer. Moreover, types 6 and 11 of the virus can be found in the mouth, oral-pharyngeal region and larynx.

HPV related cancer mainly affects the genital area (anal, cervical, vaginal, vulvar or penile cancer). The connection between HPV and head and neck cancer, especially oral and laryngeal, is a fact so we currently have HPV positive carcinomas (a form of epithelial cancer with the most frequent histo-pathological form) and HPV negative carcinomas, with major implications in the disease’s prognosis.

HPV vaccine, which is administered so as to prevent cervical cancer and emergence of pre-malignant lesions determined by HPV type of viruses, can also offer protection against oropharyngeal and laryngeal malignant lesions and pre-malignant lesions (papilloma), since the viral types involved are the same. However, studies in this direction have not yet been completed.  

At the moment, there are ongoing European studies focusing not only on HPV infection prevention in the upper respiratory tract, but also on an increase in specific immunity against cancer causing viruses 16 and 18.

Epidemiologically, HPV vaccination might drop the risk of getting sick, both as regards genital papillomatosis (venereal) and as regards upper respiratory tract papilloma. Vaccination of healthy contacts is also recommended, given how the disease is transmitted.



Dr. Corina Mella: Sexul oral practicat cu mai mult de 6 parteneri poate duce la cancer oro-faringian determinat de HPV

Se cunoaste faptul ca fumatul si consumul de alcool sunt principalii factori de risc in aparitia cancerului de cap si gat. Studii mai recente au aratat insa ca infectia cu HPV (human papilloma virus) este, poate, cel mai important factor, crescand riscul de cancer de 32 de ori, fata de cresterea de numai 3 si respectiv 2,5 ori in cazul fumatului si consumului de alcool. Conform studiilor lui  M. Gillison exista 2 cai de inducere a cancerului capului si gatului: una- prin efectele carcinogenetice (efectele de inducere a cancerului) ale fumatului si alcoolului, cealata prin instabilitatea genomica indusa de HPV, o afectiune cu transmitere sexuala. Surprinzator, nu pare sa existe sinergism intre expunerea la HPV si fumat sau consumul de alcool.

Studiul efectuat de M. Gillison, in urma compararii unui lot de 100 pacienti diagnosticati recent cu cancer de orofaringe cu 200 subiecti sanatosi, a aratat ca, contactul oro- genital este strans corelat cu cancerul oro-faringian. Participantii la studiu care au declarat mai mult de 6 parteneri sexuali diferiti (pentru sex oral), au un risc de imbolnavire de cancer oro-faringian determinat de HPV de 8,6 ori mai mare decat ceilalti. Nu poate totusi fi exclusa transmiterea virusului prin sarut sau pe cale tegumentara.

Rezervorul de HPV

HPV se gaseste in mucusul tractului genital, in saliva, in urina si in sperma. Tipurile virale cu risc inalt de carcinogeneza pentru cancerul de cap si gat sunt tipul 16 si 18, la fel ca si pentru cancerul cervical. In plus, in cavitatea bucala, oro-faringe, laringe se mai intalnesc tipurile 6 si 11 de virus.

Cancerele cu determinism HPV afecteaza in principal zona genitala (cancere anale, cervicale, vaginale, vulvare, peniene). Legatura intre HPV si cancerele capului si gatului, in special cu cele orale si laringiene, este o certitudine, astfel incat vorbim in prezent de carcinoame (o forma de cancer epithelial cu cea mai frecventa forma anatomo-patologica)- HPV pozitive si carcinoame-HPV negative cu implicatii majore in prognosticul bolii.

Vaccinul impotriva HPV care se administreaza in scopul prevenirii cancerului de col uterin si a aparitiei leziunilor premaligne determinate de virusuri de tip HPV, poate oferi protectie si impotriva leziunilor premaligne (papiloame) si maligne orofaringiene si laringiene, intrucat tipurile virale implicate sunt aceleasi, desi studiile in acest sens nu au fost inca finalizate.

In prezent exista studii europene in derulare care vizeaza nu numai preventia infectiei cu HPV la nivelul tractului respirator superior, ci si cresterea imunitatii specifice impotriva virusurilor oncogene 16 si 18.

Din punct de vedere epidemiologic, vaccinarea impotriva HPV ar putea scadea riscul de imbolnavire nu numai pentru papilomatoza genitala (veneriana), ci si pentru papiloamele tractului respirator superior. De asemenea, se recomanda vaccinarea contactilor sanatosi, tinand cont de modalitatile de transmitere a bolii.